Prevalence of Cancer Survivors in 2019 Among Patients Diagnosed Between 1975 and 2019: A Population-Based Study in Japan.

Introduction

The incidence of cancer is increasing worldwide. In Japan, approximately 0.85 million cancers were diagnosed in 2011, increasing to 0.99 million by 2021 [ 1 , 2 ]. The prognosis of patients with cancer has improved, with the 5‐year relative survival for all cancer sites rising from 54.3% in 1997–1999 to 64.1% by 2009–2011 [ 3 , 4 ]. Cancer survivors require comprehensive, long‐term support including follow‐up medical care, rehabilitation, and monitoring for late effects, which often differ from the resources needed for the treatment of patients with newly diagnosed cancers [ 5 ].

The number of people who have experienced cancer at a specified point in time, known as cancer prevalence, is a useful measure for planning survivorship care. In 2020, the estimated number of individuals living after a cancer diagnosis was 23.7 million in Europe [ 6 ], rising by approximately 3% per year in Italy [ 7 ]. In the United States (US), the estimated number of cancer survivors was 13.7 million in 2012, and was projected to reach 18.0 million by 2020 [ 8 ]. Moreover, approximately 40% of all prevalent individuals had survived > 10 years after a cancer diagnosis [ 6 , 8 ].

Asian countries may have distinct patterns in the prevalence of cancer survivors owing to differences in population characteristics, cancer epidemiology, and distribution of cancer types. For example, the incidence of stomach cancer remains substantially higher in East Asia than in Western countries [ 9 ], suggesting corresponding differences in the composition of long‐term survivors. However, the analysis of prevalence requires many years of incidence data and information on the vital status of patients, which is currently unavailable in most Asian countries [ 10 ]. In Japan, previous studies have reported only limited (5‐ or 10‐year) cancer prevalence [ 11 , 12 , 13 ]. The National Cancer Registry, established in 2016, is also insufficient for estimating the prevalence of long‐term survivors. Additionally, reports of cancer prevalence in Korea and in Hong Kong are limited to specific cancer types and duration of prevalence [ 14 , 15 ]; thus, long‐term survivors remain understudied in Asian countries. Addressing this gap requires estimates of cancer prevalence, including long‐term survivors.

Using over four decades of large‐scale subnational cancer registry in Japan, the present study aimed to estimate the prevalence and characteristics of cancer survivors.

Material and Methods

Data Source and Study Cohort

This cross‐sectional study included patients with cancer from the Osaka Cancer Registry (OCR), a population‐based registry that covers the entire Osaka Prefecture. Osaka Prefecture is the third most populous prefecture in Japan, with 8.8 million residents, representing 7% of the national population [ 16 ]. The OCR data are included in Cancer Incidence in Five Continents, volumes III to XII [ 17 ]. The OCR contains individual‐level data, including sex, age, dates of diagnosis and death, codes for cancer type according to the International Classification of Diseases 10th edition (ICD‐10), codes for cancer topography and morphology according to the International Classification of Diseases for Oncology, 3rd Edition (ICD‐O‐3), and treatment summaries. The OCR defines patient sex as that assigned at birth.

The study population in the present study included all individuals diagnosed with cancer between 1975 and 2019, who were alive as of December 31, 2019, in the OCR database. The analysis excluded patients notified by death certificates only; those with carcinoma in situ; and those with uncertain age at diagnosis, sex, or date of death. Additionally, because the population data in 5‐year age groups were available only up to 94 years of age, patients aged ≥ 95 years in 2019 were excluded. Age in 2019 was calculated by summing the age at diagnosis and the years that had elapsed since diagnosis.

We determined the vital status in the OCR using death certificates and official resident registries. Mortality information is updated annually through death certificates submitted to municipalities, in accordance with the Family Register Act. We confirmed survival status using the resident registry, with follow‐up until at least December 31, 2019, as described previously [ 18 ]. Patients who move out of Osaka Prefecture were also followed through the resident registry system, allowing continued confirmation of their vital status. Individuals without recorded deaths were considered alive.

Statistical Analysis

We examined the prevalence of cancer survivors, defined as the number of individuals diagnosed with cancer still alive at the end of 2019. When calculating the prevalence of all types of cancer combined, we considered only the first primary cancer for patients with multiple primaries [ 6 , 19 ]. Cancer prevalence is presented by sex, according to the time since diagnosis, cancer type, and age in 2019. We classified cancer types into 22 groups according to ICD‐10 as follows: oral cavity and pharynx (C00–C14), esophagus (C15), stomach (C16), colorectal (C18–C20), liver (C22), gallbladder, etc. (C23, C24), pancreas (C25), larynx (C32), lung (C33, C34), skin (C43, C44), breast (C50), uterine (C53–C55), ovary (C56), prostate (C61), bladder (C67), kidney and urinary tract (C64–C66, C68), brain (C70–C72), thyroid (C73), malignant lymphoma (C81–C85, C96), multiple myeloma (C88, C90), leukemia (C91–C95), and others [ 2 ]. We also calculated subtype‐specific prevalence estimates for malignant lymphoma and leukemia. In addition, to illustrate the long‐term cancer survivor population, we also calculated cumulative prevalence according to time since diagnosis (0–4.9, 5–9.9, 10–14.9, 15–19.9, 20–24.9, 25–29.9, and 30+ years).

Cancer prevalence was also expressed as the proportion per 100,000 individuals or as a percentage of the Osaka general population (8.8 million in total) [ 16 ]. We calculated crude proportions using the Osaka general population. Age‐standardized proportions were also estimated via the direct standardization method using the Japanese standard population 2015, Segi's World‐Standard Population, and the European Standard Population 2013 [ 20 , 21 , 22 ]. We estimated 95% confidence intervals (CIs) using the Clopper–Pearson method [ 23 ].

We normalized sex‐ and age‐specific cancer prevalence in Osaka Prefecture to the Japanese population (126.2 million in total) to estimate the national prevalence. National population data were obtained from the Portal Site of the Official Statistics of Japan [ 21 ]. We calculated the 95% CIs for national prevalence estimates using the Wilson method based on the corresponding crude proportions and population denominators [ 24 ].

Analyses were performed using Stata 18 (StataCorp, College Station, Texas, US).

Results

Baseline Characteristics

According to the OCR, 1,767,289 individuals were diagnosed with cancer between 1975 and 2019. Among these, we excluded 171,850 records because they were notified by death certificates only; 123,409 diagnosed with carcinoma in situ; 148, 53, and 3 for uncertain patient age at diagnosis, sex, and date of death; and 27,996 for patient age ≥ 95 years on December 31, 2019. Thus, this study included 1,300,952 individuals, 126,730 of whom had multiple primary cancers. The total number of cancers was 1,443,830.

Table 1 summarizes the characteristics of all cancers diagnosed between 1975 and 2019. Among the 1,300,952 patients, 746,239 (57%) were male, and 764,957 (59%) were aged ≥ 65 years at cancer diagnosis. A total of 168,014 were diagnosed in 1980–1989, and 511,330 in 2010–2019. The most common cancers in males and females were stomach cancer ( n = 176,774, 21%) and breast cancer ( n = 118,530, 19%). Based on the available treatment information, 52% of patients with cancer underwent surgery, 35% received chemotherapy, and 12% underwent radiotherapy.

Prevalence of Cancer Survivors in Osaka Prefecture in 2019

Of the 1,300,952 patients, 461,489 were alive in 2019, corresponding to 5.4% of the Osaka population and a crude prevalence proportion of 5221 per 100,000. Table 2 summarizes the prevalence of cancer survivors in 2019 by sex. Of the 461,489 survivors, 228,066 were male and 233,423 were female. Approximately 29% of male (66,501 of 228,066) and 38% of female (88,933 of 233,423) survivors had lived for ≥ 10 years since diagnosis, accounting for 34% of all survivors. In males, the most common cancer was stomach cancer ( n = 54,023; 1274 per 100,000), followed by prostate ( n = 49,632; 1171 per 100,000) and colorectal ( n = 48,949; 1155 per 100,000) cancers. In females, breast cancer was the most common ( n = 79,812; 1735 per 100,000), followed by colorectal ( n = 38,535; 838 per 100,000) and stomach ( n = 26,934; 586 per 100,000) cancers. Subtype‐specific prevalence estimates for malignant lymphoma and leukemia are presented in Table S1 . Age‐standardized proportions are presented in Tables S2–S4 based on different standard populations: the Japanese Standard Population 2015 (Table S2 ), the World Standard Population (Table S3 ), and the European Standard Population 2013 (Table S4 ). The crude prevalence of cancer survivors was 2180 per 100,000 for 5 years and 3462 per 100,000 for 10 years since diagnosis, respectively (Table S5 ).

Figure 1 shows the age distributions of cancer survivors by sex and cancer type in 2019. For all cancer types combined, survivors aged ≥ 65 years accounted for 83% of males ( n = 188,881) and 70% of females ( n = 163,331). Overall, 76% of all cancer survivors (352,212 of 461,489) were aged ≥ 65 years. According to cancer type, survivors aged ≥ 65 years accounted for > 80% of patients with 12 cancer types, including prostate, bladder, and stomach cancers. In contrast, among brain tumors, thyroid cancer, leukemia, and female breast, uterine, and ovarian cancers, 40%–70% of the survivors were < 65 years of age.

Figure 2 shows the number and proportions of cancer survivors by years since diagnosis and cancer type, stratified by sex. Among males, prostate cancer was the most common within 10 years since diagnosis, whereas stomach cancer predominated among those who survived ≥ 10 years. Among females, breast cancer had the highest number and proportion across all time periods, while the proportions of stomach and uterine cancers increased with time since diagnosis.

Comparison of cancer prevalence across age groups in the Osaka population revealed an overall higher prevalence among males than females in older age groups (Figure 3 ). In age groups < 60 years, the proportion of males was slightly lower than that of females (approximately 1%–6% vs. 2%–7%). This trend was reversed in the age group ≥ 70 years, with 16% of men aged 70–74 years having been diagnosed with cancer compared with 11% of females of the same age group. This difference increased in the older age groups.

Estimated National Prevalence in Japan

In Japan, an estimated 6,901,670 (95% CI: 6,824,450–6,954,658; 3,464,707 males [95% CI: 3,421,251–3,509,047] and 3,436,963 females [95% CI: 3,390,233–3,484,616]) individuals were alive after a cancer diagnosis in 2019, corresponding to 5.5% of the total population of 126.2 million (Table 3 ). Based on the 5‐year prevalence (2425 per 100,000 males and 1955 per 100,000 females; Table S5 ), the estimated number of cancer survivors who had lived up to 5 years since diagnosis was 2,856,365 (95% CI: 2,795,999–2,918,746; 1,549,051 males [95% CI: 1,518,684–1,580,430] and 1,307,313 females [95% CI: 1,277,315–1,338,315]). Similarly, based on the 10‐year prevalence (3811 per 100,000 males and 3141 per 100,000 females; Table S5 ), the estimated number of cancer survivors who had lived for up to 10 years since diagnosis was 4,544,913 (95% CI: 4,470,054–4,621,712; 2,437,585 males [95% CI: 2,400,361–2,475,771] and 2,107,328 females [95% CI: 2,069,692–2,145,940]). Estimates of 5‐year prevalence of cancer survivors by age in 2019 and cancer site are presented in Table S6 , with corresponding 10‐year prevalence estimates shown in Table S7 .

Discussion

In this population‐based study using over four decades of OCR data, we identified 461,489 cancer survivors living in Osaka Prefecture in 2019, corresponding to 5.4% of the prefectural population. Notably, 34% had survived for ≥ 10 years after diagnosis, and 76% were aged ≥ 65 years in 2019. These results highlight a substantial population requiring long‐term, age‐appropriate survivorship care.

The prevalence observed in Osaka Prefecture (5.4% of the general population) was comparable with that reported for Europe in 2020 (5.0%) [ 6 ]. The crude prevalence proportion (5221 per 100,000) was also within the range reported in European countries (3026–5861) [ 6 ]. Among cancer survivors in the present study, 38% of females and 29% of males had lived ≥ 10 years after a cancer diagnosis. These proportions were lower than the estimated complete prevalence proportions in the US (50% of females and 44% of males) [ 8 ] and Europe (44% of females and 32% of males) [ 6 ], probably reflecting differences in case mix as well as differences in follow‐up duration and modeling approaches.

The relatively high proportion of colorectal and stomach cancer survivors in Japan can be explained by the higher incidence of these cancers compared with that in Western countries and favorable survival [ 17 , 25 ]. The observed prevalence of prostate cancer is likely close to the overall prevalence, given that it is typically diagnosed at older ages. Nevertheless, the prevalence was lower than that reported in Western countries, which may reflect historically higher incidence rates in those populations [ 17 ]. For breast cancer, the lower prevalence compared with Western countries may also reflect a historically higher incidence in those populations, although under‐ascertainment of very long‐term survivors may have additionally contributed [ 6 , 8 , 17 ].

The proportion of cancer survivors aged ≥ 65 years in 2019 (83% of males and 71% of females) in the present study was higher than that reported for Europe and the US in 2020 [ 6 , 26 ]. This can be explained by Japan being a super‐aged society. In 2019, 28.4% of the Japanese population was aged ≥ 65 years, the typical retirement age in Japan, and this proportion is projected to reach 35.7% by 2050 [ 21 , 27 ].

Cancer prevalence in the general population was higher among older age groups in the present study, as also reported in the US [ 28 ]. Older adults with cancer require personalized care to maintain healthy longevity, including comorbidity management, nursing care, and rehabilitation [ 29 , 30 ]. Moreover, older adults have widely variable physical and psychosocial conditions, which may be further amplified among cancer survivors [ 31 ]. Thus, understanding their cancer experiences is essential for planning age‐appropriate survivorship care. Survivors aged ≥ 65 years accounted for > 80% of patients across 12 cancer types in the present study, including prostate, bladder, and stomach cancers. Maintaining quality of life for these older cancer survivors through management of urinary dysfunction, nutritional problems such as weight loss and malabsorption, comorbidities, and functional decline is particularly important.

In contrast, 40%–70% of survivors with brain tumors, thyroid cancer, leukemia, or female breast, uterine, and ovarian cancers were < 65 years of age. Notably, approximately 30% of brain tumor and leukemia survivors were aged < 40 years, reflecting the higher incidence and relatively favorable prognosis of these cancers at a younger age [ 18 , 32 , 33 ]. For example, acute lymphoblastic leukemia is the predominant subtype in childhood, and improved survival in this group may have contributed to the accumulation of younger survivors [ 18 , 34 ]. To support quality of life for this younger generation, comprehensive care should include support for returning to education or work, prevention of secondary cancers, and reproductive health care after cancer treatment. These issues were also highlighted in the 4th Term Basic Plan to Promote Cancer Control Programs in Japan, initiated in 2023.

Among younger female survivors, breast and uterine cancers were particularly common. Breast cancer, the most common cancer among females [ 1 ], accounted for 30% of female cancer survivors because of its relatively good prognosis [ 3 ]. However, some breast cancer survivors require continued adjuvant therapy, long‐term clinical follow‐up, appearance care, and psychological support for recurrence anxiety [ 35 , 36 ]. Uterine cancer also exhibited a relatively high proportion of long‐term survivors. In Japan, the incidence of cervical and other human papillomavirus (HPV)‐associated cancers is expected to revert to prevaccine levels due to the suspension of official HPV vaccination recommendations for women born in the 2000s [ 37 ]. Thus, continued support for patients with cervical cancer remains an important policy issue in Japan.

We estimated that approximately 6.9 million people in Japan were living after a cancer diagnosis in 2019. This estimate may provide a useful reference, as regional differences in cancer incidence and survival between Osaka and Japan are small (age‐standardized incidence per 100,000 in 2015: 383 vs. 362; 5‐year relative survival in 2009–2011: 62.7% vs. 64.1%) [ 1 , 2 , 3 ]. Moreover, the OCR is one of the few data sources in Japan that allows estimation of cancer prevalence, including long‐term survivors. Our estimate of the 5‐year prevalence (2.86 million) was similar to that of the Global Cancer Observatory report (2.74 million) [ 38 ]. In addition, the 5‐year prevalence, including that for cancers in children, adolescents, and young adults, as well as patterns for major cancer types, are broadly similar across different regions such as Shimane and Aichi Prefectures [ 18 , 39 , 40 ]. The 10‐year prevalence (4.54 million) was slightly lower than model‐based estimates (5.02 million) [ 13 ], possibly because our analysis considered only the first primary cancer [ 6 , 19 ], whereas previous studies included multiple primaries. When counting the estimated total number of cancers, the 10‐year prevalence was 5.09 million, supporting the validity of the model‐based estimates.

This is the first study in Asia to examine cancer survivors over a long period of more than 10 years, providing the unique opportunity to characterize long‐term survivorship patterns. We identified a subgroup of survivors requiring long‐term treatment and follow‐up care. This study also illustrates the potential of long‐term registry data, such as that from the OCR, to identify not only survivors requiring continuous care but also those who may be considered functionally cured. For example, previous studies reported that patients with stomach cancer who have survived ≥ 5 years after diagnosis are generally considered cured [ 25 ], in our results, the proportion of stomach cancer among long‐term survivors increased with time since diagnosis. Such data may inform healthcare planning and societal issues, including reducing employment discrimination, mitigating financial toxicity, and promoting the “right to be forgotten” [ 41 ].

This study has several limitations. First, because we aimed to report cancer prevalence based on currently available observed data, the estimates do not represent the complete prevalence. Although providing the longest available record, the 44 years of the OCR data do not cover the entire life span of all individuals. Differences between our estimates and complete prevalence may reflect differences in case mix, as well as differences in the duration of follow‐up and modeling approaches. Second, the exact number of patients lost to follow‐up could not be determined because related data were unavailable. This limitation may have a greater impact among long‐term survivors compared with recently diagnosed patients. For context, in the OCR in 2019, the proportion of patients lost to follow‐up was 1.6% at 10 years of follow‐up and 1.5% at 5 years of follow‐up [ 42 ]. Third, given the cross‐sectional design of this study, caution is warranted when interpreting our findings in light of temporal trends in cancer prevalence. Because cancer incidence and survival in Osaka Prefecture have generally increased or remained stable [ 19 ], our 2019 prevalence estimates may be slightly higher than those that would have been observed before 2018 [ 12 ]. Future studies should investigate temporal trends and future projections of cancer prevalence, as well as employ more detailed subtype‐specific analyses. Finally, the national prevalence in Japan was estimated based on that in Osaka Prefecture because registries with long‐term data on patients' vital status were limited. Patterns of 5‐ and 10‐year prevalence of cancer survivors by cancer site were broadly consistent with previous estimates, although comparisons by age in 2019 should be interpreted with caution owing to differences in analytical approaches that define age categorization and discrepancies in the handling of multiple primaries [ 13 ]. Comparisons for long‐term survivors are also difficult because registries with long‐term data on patients' vital status are limited in Japan.

In conclusion, we reported 461,489 individuals living after a cancer diagnosis in Osaka Prefecture (corresponding to a prevalence of 5221 per 100,000) in 2019. Estimating the prevalence of cancer survivors across all age groups, including long‐term survivors, offers important insights into the short‐ and long‐term burdens of cancer. These data provide a valuable resource for cancer control efforts, particularly for planning healthcare services and survivorship support across different life stages.

Author Contributions

Haruka Kudo: conceptualization, methodology, formal analysis, investigation, data curation, writing – original draft, funding acquisition. Yoshihiro Kuwabara: conceptualization, methodology, writing – review and editing. Kenji Kishimoto: conceptualization, methodology, writing – review and editing. Toshitaka Morishima: conceptualization, methodology, writing – review and editing. Isao Miyashiro: conceptualization, methodology, data curation, supervision, project administration, writing – review and editing, funding acquisition. Kayo Nakata: conceptualization, methodology, data curation, writing – review and editing, supervision, project administration, funding acquisition. Yoko Iwaki: conceptualization, methodology, writing – review and editing. Toshiki Ikawa: conceptualization, methodology, writing – review and editing.

Funding

This study was supported by Health Labor and Welfare Sciences Research Grants (JPMH23EA1033) from the Ministry of Health, Labor and Welfare, Japan, and JSPS KAKENHI (25K24177). The funding sources had no role in the study design, data collection, analysis, or interpretation, writing of the report, or decision to submit the article for publication.

Ethics Statement

This study was approved by the Institutional Review Board of Osaka International Cancer Institute (approval numbers 21218 and 22074). Information from the OCR was processed based on the Act on the Promotion of the Cancer Registry, and the requirement for informed consent was waived. Personal identifiable information was removed from the database before use.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Table S1: Subtype‐specific prevalence of malignant lymphoma and leukemia in 2019 among patients diagnosed between 1975 and 2019 in Osaka, Japan.

Table S2: Age‐standardized prevalence proportion of cancer survivors in 2019 (standardized to the Japanese Standard Population 2015), by sex, among patients diagnosed between 1975 and 2019 in Osaka, Japan.

Table S3: Age‐standardized prevalence proportion of cancer survivors in 2019 (standardized to the World‐Standard Population), by sex, among patients diagnosed between 1975 and 2019 in Osaka, Japan.

Table S4: Age‐standardized prevalence proportion of cancer survivors in 2019 (standardized to the European Standard Population 2013), by sex, among patients diagnosed between 1975 and 2019 in Osaka, Japan.

Table S5: Cumulative prevalence of cancer survivors by sex and time since diagnosis in 2019, Osaka, Japan.

Table S6: Estimation of 5‐year cancer prevalence in Japan, 2019.

Table S7: Estimation of 10‐year cancer prevalence in Japan, 2019.

Acknowledgments

We would like to thank Editage ( www.editage.jp ) for English language editing and their assistance in creating the graphical abstract for this paper.

Data Availability Statement

Requests to use datasets should be made to the OCR. Further information is available from the corresponding author upon reasonable requests.

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Associated Data

Supplementary Materials

Table S1: Subtype‐specific prevalence of malignant lymphoma and leukemia in 2019 among patients diagnosed between 1975 and 2019 in Osaka, Japan.

Table S2: Age‐standardized prevalence proportion of cancer survivors in 2019 (standardized to the Japanese Standard Population 2015), by sex, among patients diagnosed between 1975 and 2019 in Osaka, Japan.

Table S3: Age‐standardized prevalence proportion of cancer survivors in 2019 (standardized to the World‐Standard Population), by sex, among patients diagnosed between 1975 and 2019 in Osaka, Japan.

Table S4: Age‐standardized prevalence proportion of cancer survivors in 2019 (standardized to the European Standard Population 2013), by sex, among patients diagnosed between 1975 and 2019 in Osaka, Japan.

Table S5: Cumulative prevalence of cancer survivors by sex and time since diagnosis in 2019, Osaka, Japan.

Table S6: Estimation of 5‐year cancer prevalence in Japan, 2019.

Table S7: Estimation of 10‐year cancer prevalence in Japan, 2019.

Data Availability Statement

Requests to use datasets should be made to the OCR. Further information is available from the corresponding author upon reasonable requests.